This paper outlines the present opportunity
for universities to support health service managers and nurses in using the WWW and
Intranets to enhance develop their continuing professional development. The paper then
offers design guidance for the building of web sites to support educational products.

Health Care Managers and Nurses in the United
Kingdom are facing the challenge of using the WWW (WWW)to help them enhance their
professional practice. This has been prompted by a range of pressures which include:

the introduction of Web technologies into
the National Health Service (NHS Executives Information Management Group);

an increasing emphasis for using the web to
support learning on University programmes and,

the pressure to join in the WWW revolution
by accessing it at home.

We have observed through teaching on open and
distance learning, under / post graduate programmes that UK Health Care managers and
nurses who do not work directly in information management are only beginning to use the
WWW for their own professional development. However the UKs National Health Service
(NHS) has now established a protected Intranet for the whole organisation (which is known
as NHSNet).

The use of this IT infrastructure is limited
by cost and major cultural concerns regarding sharing patient data electronically (Eaton,
L. 1997). The current reality is that most health care managers and nurses are supported
by older IT systems installed during the 1980s and early 1990s. A major frustration for
these two groups is the continued growth in the home PC market and the ability of the
health care professional to have access to the WWW at home but probably not at work.

The NHS during 1997 and 1998 reviewed its
strategy for Information Management and Technology. This review was strongly influenced by
the change of UK government in May 1997 and the following publication of the new Labour
governments major policy document The New NHS  Modern and Dependable
(Department of Health, 1997). There was a recognition here, that the ability of the NHS in
remaining a national system, responsive to patient and public demand, partly depended on
information technology. The implication here is that the health care professional should
be able to use the potential of the NHSNet and the public WWW to speed up communication
and enhance their practice. The long-term goal of the NHS is to establish virtual
communities of health care organisations who can interrogate each others computer
databases. At present this is only happening on a pilot basis in some areas of the UK
(Cross, 1998).

Universities have therefore a major role and
opportunity to prepare the two identified professional groups, to integrate WWW searching
and communication techniques into their professional development.

The implied expectations now made of most
health care professionals by their employers and their professional bodies / associations
are to:

base their clinical and managerial practice
on high quality research;

develop strong professional networks;

and to be able to communicate far more
rapidly across health and social care organisations.

The individual and organisational capacity to
address these increasing expectations can be increased if a healthcare professional with
their colleagues can effectively use WWW technologies whether on the public WWW or using
the NHSNet.

This has created a challenge to the open and
distance learner, which the tutor must support if the learner is to successfully address
this challenge (Daloz 1986).

Open Learning is empowering, allowing
students to develop themselves and become autonomous practitioners and critical thinkers
(Cassidy & Lucas 1998). This belief is congruent with Daloz (1986) who believes that
success (in terms of change) can only be achieved if there is maximum support alongside
maximum challenge.

The use of a tool, which can further develop
these skills, can enhance the learning experience and create more support and challenge. A
web site can be one tool to which the tutor turns to support the student to become more
adventurous in their exploration of knowledge thus enhancing the challenge. Equally this
tool could supplant the tutor by itself being supportive and challenging. The WWW poses a
great challenge to health care professionals therefore the key to the support must be the
design of the web site itself.

With simple inexpensive tools anyone can
publish on the Web in a few hours. This immediacy fosters dynamism, creativity and chaos.
Almost infinite variety is a defining characteristic of the Web but consistency can not be
expected. When variety means unreadable, slow and confusing the reader is unlikely to
benefit. Just as in movie making, there are key principles which should be followed,
1,000's of cheap camcorders do not make thousands of Steven Spielbergs, the same is true
of Web authoring, thousands of authors have created thousands of pages of rubbish.

For designers of educational material, this is especially salient. The interface should
engage the student, not alienate them.

So are there style rules for the uninitiated?
In fact there are, one of the best is written by Tim Berners-Lee (1998), the present
director of the Consortia (W3C). Some of his suggestions are considered under the
following headings:

Structure

Layout

Size of documents

Whether to refer to another document or
copy it

Printing and the relationship with print
documents.

These considerations, and some of
Berners-Lees advice in each section, are discussed below.

Educators will have a clear body of
information to communicate. Berners-Lee recommends the retention of this structure,
without it readers dont know where they are and cannot plan ahead. The author should
also consider the readers previous knowledge of the subject. If they are newcomers,
then the organisation of knowledge may be as important as the knowledge itself.
Conversely, knowledgeable students may find a rigid, linear framework off putting.
Overlapping content with different starting points and layout, which reflects prior
knowledge can accommodate each. For example a beginners page may be devoted to the
structure of the cell, a graphical representation may be used with labels, which are
hyperlinks to separate pages on each of the specific structures within the cell. The
advanced reader may simply choose structures from an alphabetical list and go straight to
the same content as the beginner, without having to navigate content already known to
them.

Tables of contents (TOC) with annotated notes
for each section provide a "road map", whose potential to promote cognitive
organisation may be enhanced by the use of visual aids or metaphors.

Learning materials should be consistent and
rigorous. Clear signposting is necessary as readers may not be able to distinguish
essential reading from non-essential, or activities from information summaries. Headings,
icons and button bars which signpost parent, same level and child level pages are all
useful ways to identify sections and permit navigation between documents.

Some students may leap straight into a later
section of your work without completing the previous section. You may wish to prevent this
by using passwords that require completion of the previous page, or you may welcome it. If
the latter, you must ensure that the content is not without context, i.e. it should relate
back to earlier principles, perhaps by making reference to these in the opening remarks.

Large documents are slow to download,
cumbersome and off-putting. However, there is no point breaking up an idea into bite size
chunks that leave the reader frustrated or with an incomplete grasp. Ideally, a well-laid
out page will take up no more than a screen and a half, permitting scrolling whilst
retaining context.

Pictures and graphics should be as small as
possible, with reduced colour depth and saved in a compressed form. Thumbnail images which
hyperlink to larger images are good practice.

Some web authoring packages enable the use of
frames, themes, Java and more. These are never necessary and rarely useful. They add
complexity and reduce speed, and most browsers cannot handle them. Significantly, the
W3org web site is one of the clearest and the most basic available, suggesting this is the
way to do it!

Much of the added value on an educational web
site will be the hyperlinks to external documents, this can save money, time and provide
information of a richness well beyond the parameters of your project. Hyperlinking is
acceptable practice, as with very few exceptions it is not regarded as publishing or a
copyright infringement. Copying content is likely to be an infringement of copyright. Even
when this not a problem, copying will date your web site as most web pages dont
remain unchanged for long. Brake (1998) cites a study that showed that on average web
pages were updated within 75 days of publication, with some lasting only 10 days.

Most if not all print documents can be turned
into web pages. Any documents in electronic form, such as word-processed documents can be
converted easily. Presentations such as PowerPoint can also be converted for web display.
Printed documents can be added via a scanner and displayed as pictures, as readable
documents in PDF format or even as elements within a new document.

Web browsers are able to print out what is
shown on the screen, with a few exceptions. Image files are not usually printed, and the
content of documents hyperlinked from the printed document are likewise unavailable to the
reader. If readers are likely to print the entire document, it is useful to create a
printable, single, long document for the purpose, and hyperlink it as such.

In direct contradiction to most Web content,
the most user-friendly and effective communication is achieved through simple, consistent,
well structured materials with a common interface and obvious sign posting and
functionality. There is simply no need for animation, video or bandwidth hogging
extras such as Java and Active X. And whilst computer enthusiasts may chafe, content
must come before style every time!

Most health care professionals are poorly
served by electronic learning media, as the technology has been slow to catch on, access
is restricted and most Universities catering for these customers have failed to see the
potential of the Virtual classroom.

The easiest way to publish electronically is
to use the Web, it enables media to be accessed from a distance or in the classroom, by
students using cheap, almost ubiquitous computer facilities. Whilst multimedia publishing
and videoconferencing are exciting, they are expensive, difficult to set up and represent
major problems in terms of enabling students access from home.

Although we argue the medium is not the
message, given that IT skills are now regarded as a core competence for an information
based workforce, the opportunity to facilitate IT skills simultaneously with other
programmed learning is too good an opportunity to be missed